A local mother was having fun at a family picnic, but couldn’t stop thinking about her 17-year-old son, who chose to stay home.

She returned home after six or seven hours to find him lethargic. He told her he’d vomited, but said nothing else. For reasons she cannot explain, she checked her medicine cabinet. Everything was gone: a cholesterol-lowering drug, decongestant, aspirin, cold medicine and Tylenol.

At the hospital, eight to 10 hours after her son swallowed all those pills, she learned it was acetaminophen — the key ingredient in Tylenol and lots of cold medicines — that put her son in danger. Doctors later determined he’d ingested 60,000 milligrams — 20 times the recommended daily limit. Had she waited longer, her son might have died of liver failure. It might already be too late to avoid a liver transplant, doctors told her.

The 40-year-old suburban resident asked that her name not be disclosed to protect her son’s identity. She contacted the Times Union to share her story because she was stunned to find Tylenol as the drug he turned to when his despair hit bottom. He was being treated for depression and bipolar disorder, but had no history of drug abuse or signs he was considering suicide, she said.

Her son later told her he learned on the Internet that he could kill himself with Tylenol, she said.

The teen is hardly alone in turning to acetaminophen to end his life. The drug is safe when used according to instructions. But it is also inexpensive and easy to obtain in large enough quantities to cause harm. Some people, including teens, use it for just that purpose, local experts said.

“Acetaminophen is the most frequent pharmacological agent taken in intentional overdoses,” said Dr. Heather Long of Albany Medical Center Hospital.

Several patients a week come to Albany Med’s Emergency Department because they’ve ingested too much of the drug, Long said.

Accidental overdoses are common, too, as people mix several over-the-counter or prescription remedies that contain the drug — like Tylenol, cold and flu remedies, or prescriptions that combine a narcotic with acetaminophen, for instance. Or they mix acetaminophen with alcohol. Any of those combinations can overwhelm the liver and be lethal, said George Fredericks, pharmacy director at Albany Memorial, Samaritan and St. Mary’s hospitals.

But attempted suicide accounts for twice as many liver injuries as accidental overdoses, according to the U.S. Centers for Disease Control and Prevention. Acetaminophen is not usually used for recreational purposes.

“I see it as a common choice in a suicide attempt, not as a drug of abuse,” said Dr. Allen Stefane, medical director of child and adolescent psychiatry at Ellis Hospital in Schenectady. “It doesn’t really have any mood-elevating or mood-altering effects.”

Symptoms of acetaminophen overdose include abdominal pain, nausea and vomiting, among others. But they often don’t appear for 24 hours, Long said.

Acetaminophen “has to be metabolized by the liver, and you have to overwhelm the body’s ability to break it down. Once that happens, you don’t start to have symptoms until you have liver damage,” Long said. “It’s not immediately.”

The antidote for acetaminophen overdose, acetylcysteine, is most effective if given within eight hours, Long said, though in some cases it can be effective later. It worked with the local mother’s son, who received it intravenously.

Acetaminophen is considered safe in daily amounts of 3,000 milligrams or less, Fredericks said. Other drugs commonly used in over-the-counter painkillers, such as ibuprofen (in Motrin or Advil) or naproxen sodium (in Aleve), can cause stomach irritation, but not serious liver damage, he said.

Some medical experts have recommended products with acetaminophen be sold in blister packs containing just a pill or two. That would make it hard to take too many, especially accidentally. But it would also increase the medications’ cost and make it difficult for elderly patients to use, Fredericks said.

Stefane urged parents to treat products with acetaminophen like prescription medicine that contains stronger painkillers. Only small amounts of either type of drug should be left within easy access of children or teens, he said.

“Suicide attempts among teens,” Stefane said, “can be impulsive and can be dangerous, and we’ve lost way too many kids.”

Michael Huber

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Michael Huber

Interactive Audience Manager, Times Union

Claire Hughes covers health care in the Capital Region for the Times Union